Do you want to create a supportive work environment?


June 22, 2013

Dr. Brian J. Nadler, Internal Medicine, Resident Physician

Here are some recommendations for change

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The Post Graduate Medical Education’s (PGME’s) Future of Medical Education in Canada – Postgraduate Project (FMEC-PG) created 10 recommendations for change to ensure an improved collective vision for the training of future physicians. One of these recommendations is to create positive and supportive learning and work environments centered on our patients. This recommendation focuses on transforming our working environments into ones that foster respect among physicians and other care providers; it is reflective of an interprofessional and intraprofessional, collaborative, patient-centered approach to care. One key component of supportive workplaces that the FMEC project also addresses is the prioritization of care provider health and well-being. Together these aspects of the medical environment are key to encouraging supportive learning and work environments.

pull quoteOne of the most effective means of ensuring supportive workplaces is by effectively tending to the emotional challenges faced by our physician colleagues and ourselves. The frequency of mental health issues in our profession is finally beginning to be recognized within the medical community. We now know, based on substantial research, that physicians, residents and medical students have disproportionately higher rates of clinical depression, anxiety disorders, severe burnout, substance abuse and suicide compared to the general population. In fact, about one-in-10 medical professionals experience suicidal ideation within any given year. This trend is startling when you consider the much lower prevalence of suicidal ideation in the general population.

Fostering an accepting and supportive culture

With this evidence in mind, it is important that medical students and resident physicians who are learning how to practice medicine also learn that it is perfectly normal for us to have periods throughout our careers where our well-being is at risk and we require help. It is essential that our medical community is open and receptive to dialogue around physician mental health issues in order to foster a culture where these kinds of issues can be addressed in an accepting and supportive way. Resident physicians should feel safe accessing the ever-growing mental health resources available before a crisis ever forces the issue. This dialogue, acceptance and safety will help create confidence in the resources available to physicians in need, thus reducing the barriers to treatment.

It is also clear that our medical programs have a role to play in developing policies to enhance and ensure the well-being of our community. Peer support groups and awareness campaigns are valuable tools for encouraging dialogue around physician mental health and creating space where sharing wellness challenges is encouraged and accepted. Furthermore, exploration of physician mental health screening tools can also be used to help normalize well-being concerns and to help those in need. After all, the earlier in our education this awareness is introduced, the sooner these common struggles can be normalized, understood and addressed and that perceived stigma surrounding physician mental health can be lessened. This type of education has the added benefit of encouraging mindful self-awareness and improving our personal insight into both ourselves and others, thus supporting physician resilience.

As mental health advocate Lieutenant-Colonel Stéphane Grenier insists, it is imperative that we “understand the importance of balancing clinical and non-clinical interventions.” Certainly, as the FMEC-PG indicates, there is a place for physicians, at every level, to foster a positive work environment by encouraging a focus on their own and their colleagues’ wellness. Training on and sensitization to physician mental health issues and the programs that are available to refer those in need can only help create this focus.

Applying what we've learned

pull quoteAs I transition from a junior to a senior resident position, I have begun applying what I have learned about physician well-being from personal experiences, committee meetings and physician health conferences. With every team I join, I establish that one of my primary goals is to ensure the well-being of the junior residents and medical students. I encourage them to come to me if they are having any wellness challenges that they feel comfortable sharing, so that I can help ensure that they have the support, resources, time and space to enhance their wellness. I also ensure that there is an opportunity for debriefing unexpected events that may have caused distress and set up regular check-ins with each member of the team to discuss any concerns.

The FMEC project provides us with some initial steps in the prioritizing of physician wellness. On an organizational level, policies and procedures need to be put in place to ensure that physicians’ mental health is supported. On an interpersonal level, physician leaders must encourage a culture where physician health can be addressed in an accepting way. The role of each of us as physicians is to create a culture where open discussions of mental health issues are encouraged and normalized. Most importantly, we must remember to start with ourselves. Often, the best way to achieve a supportive learning and work environment is to ensure that our own well-being is being recognized and addressed, making it clear to the team that wellness is a priority.


The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.